Deep Vein Thrombosis Status Post DCS type I

[Kevrumbo]

Any studies done regarding the incidence or susceptibility of Deep Vein Thrombosis (DVT) and/or Pulmonary Embolism (PE) in the days following DCS and Hyperbaric Treatment?

I was treated last weekend for a type one bends hit in Truk Lagoon (write-up about that later when I get back home), and am now convalescing in Honolulu after a Hospital Emergency Room visit to rule out DVT, PE with history of DCS & HBOT three days earlier in Truk. I arrived in Honolulu from Chuuk with complaint of left calf pain and mild shortness-of-breath, status post long transpacific airline flight. (Yes Lynne, the triage nurse had the ER Doc see me immediately with no waiting upon presenting with these symptoms). . .

Bloodwork D-dimer's were elevated, so the ER Physician ordered a CT Scan with contrast of my Lungs to look for a potential PE (turned out negative). Ultrasound to look for clots in my left leg also turned out to be negative. Was handed over to the Kuakini Hyperbaric Facility here in Honolulu to undergo additional precautionary Hyperbaric Oxygen Therapy (HBOT). (Also let them know about my pinched nerve in my neck that could also mimic type two DCS symptoms). Doc's say I can't fly out for at least a few more days, and prescribed baby aspirin to thin my blood out in preparation for the flight back to Los Angeles.

My month's vacation is prematurely over and I can't dive again for at least a month afterward; but hey --at least I'm stuck here in Paradise with DAN picking-up my hotel bill. . .

 

[Dr Deco]

Hello Kevrumbo:

It sounds as if you have a tricky problem – but in a very nice tropical location.
I have not heard of DVT post-HBO treatment, but lying still and inactivity on airplanes can be a receipt for trouble. [Inactivity on rail trips has been identified as a problem. It is not confined to planes.]

Calf pain, as contrasted with the "bends," sounds as if it is a problem distinct from your original knee pain. If there is a blood flow [perfusion] problem, HBO could be identified as a treatment option since it is relatively innocuous.

I hope that things go well in the future.

Dr Deco :doctor:
The next class in Decompression Physiology for 2008 is November 15 - 16.
This class is at the USC campus in Los Angeles.
Advanced Decompression Physiology Seminar Information

 

[openmindOW]

I wish you a speedy recovery.

 

[Saturation]

Sorry to hear, Kev. D-dimer may be elevated post DCS to suggest you really did have DCS, rather than pain due to something else. Its proper to extend a d-dimer workup as its highly associated with DVT.

D-dimer can be elevated in general causes of inflammation, such as with DCS.


Activation of coagulation in decompression illness. [Aviat Space Environ Med. 1998] - PubMed Result

 

[Kevrumbo]

Just to clarify for the Mod Doc's: The original area & locus of discomfort prompting me to get HBOT in Truk was the left shoulder/upper arm & elbow, pain only with no signs of neurological deficits. On a scale of 1 to 10, the pain was a constant 6 with impulses of 10+ (now I know why they call it the bends! --you literally double over when those sharp pain spasms hit. . .:shocked2.

The calf pain (scale was a constant 4 out of 10 with sharp impulses of 6) after arriving in Honolulu was a totally different area and not part of the original symptoms in Truk; together with the shortness-of-breath, I became very concerned about a possible DVT and took a cab to the nearest Level 1 Trauma Center (The Queen's Medical Center). . .

 

[Saturation]

You're right to think of it as a DVT +/- PE given the symptoms.

By chance, did they do a CK level? Do you know what it was? Where there any other blood test abnormals?

Just to clarify for the Mod Doc's: The original area & locus of discomfort prompting me to get HBOT in Truk was the left shoulder/upper arm & elbow, pain only with no signs of neurological deficits. On a scale of 1 to 10, the pain was a constant 6 with impulses of 10+ (now I know why they call it the bends! --you literally double over when those sharp pain spasms hit. . .:shocked2.

The calf pain (scale was a constant 4 out of 10 with sharp impulses of 6) after arriving in Honolulu was a totally different area and not part of the original symptoms in Truk; together with the shortness-of-breath, I became very concerned about a possible DVT and took a cab to the nearest Level 1 Trauma Center (The Queens Medical Center). . .

 

[Kevrumbo]

No, only the D-dimer abnormality was mentioned which motivated the ER Doc to order the Chest CT Scan with contrast (and worried the-hell-out-of-me as well). He then also delivered a 1mg intravenous shot of pain-killer of which I fully appreciated & enjoyed (Dilaudid --"the Champagne of Pain Killers"). . .

 

[ScubaAndDreams]

Any studies done regarding the incidence or susceptibility of Deep Vein Thrombosis (DVT) and/or Pulmonary Embolism (PE) in the days following DCS and Hyperbaric Treatment?

I was treated last weekend for a type one bends hit in Truk Lagoon (write-up about that later when I get back home), and am now convalescing in Honolulu after a Hospital Emergency Room visit to rule out DVT, PE with history of DCS & HBOT three days earlier in Truk. I arrived in Honolulu from Chuuk with complaint of left calf pain and mild shortness-of-breath, status post long transpacific airline flight. (Yes Lynne, the triage nurse had the ER Doc see me immediately with no waiting upon presenting with these symptoms). . .

Bloodwork D-dimer's were elevated, so the ER Physician ordered a CT Scan with contrast of my Lungs to look for a potential PE (turned out negative). Ultrasound to look for clots in my left leg also turned out to be negative. Was handed over to the Kuakini Hyperbaric Facility here in Honolulu to undergo additional precautionary Hyperbaric Oxygen Therapy (HBOT). (Also let them know about my pinched nerve in my neck that could also mimic type two DCS symptoms). Doc's say I can't fly out for at least a few more days, and prescribed baby aspirin to thin my blood out in preparation for the flight back to Los Angeles.

My month's vacation is prematurely over and I can't dive again for at least a month afterward; but hey --at least I'm stuck here in Paradise with DAN picking-up my hotel bill. . .

Sorry to hear about that. You didn't go with Jo & company by any chance did you? They were just there. Hope you get better soon....you are just down the road from me.

Sherm

 

[cutlass]

FYI: CK or creatine kinase is an indicator of muscle damage. The MM fraction is associated with skeletal muscle.

More FYI: Epocrates is a fairly popular site for portable medical software. There're a lot of freebies and this one is for DVT. Of course, this is all just generally informational/educational and shouldn't be interpreted or applied to any case without appropriate training.

p.s. Queen's is a Level I now? I know they were a II for the longest time and were pushing hard for a I. The new ED wing was part of that effort.

 

[Kevrumbo]

Still looks like some on-going construction/remodeling being done inside the ER Dept of Queen's.

Yes Sherman, I was with the Jo and the IDH group 07 to 15 Oct. They video'd the initial trip over to Truk's Chamber and the start of the treatment (much to my chagrin) . . .I was by myself when I checked into Queen's ER and later transferred to UH's Kuakini Chamber.